Provider Demographics
NPI:1700281474
Name:IHEZUE, SHARON CHIDINMA
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:CHIDINMA
Last Name:IHEZUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 MANDAN RD
Mailing Address - Street 2:APARTMENT 102
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2133
Mailing Address - Country:US
Mailing Address - Phone:240-264-9201
Mailing Address - Fax:
Practice Address - Street 1:10456 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2321
Practice Address - Country:US
Practice Address - Phone:301-937-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22913183500000X
VA0202213479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist